Background
Methods
Study design and population
Baseline geriatric screening and assessment
Follow-up
Statistical analysis
Results
Patient characteristics
Age, years (median (range) (n = 937) | 76 (70 – 95) | ||||
---|---|---|---|---|---|
n | % | 95% CI | |||
Gender (n = 937) | - Female | 595 | 63.5 | 60.4-66.6 | |
- Male | 342 | 36.5 | 33.4-39.6 | ||
Tumor type (n = 937) | - Carcinoma | - Breast | 379 | 40.4 | 37.3-43.6 |
- Colorectal | 193 | 20.6 | 18.0-23.2 | ||
- Lung | 73 | 7.8 | 6.1-9.5 | ||
- Ovarian | 59 | 6.3 | 4.7-7.9 | ||
- Prostate | 84 | 9.0 | 7.1-10.8 | ||
- Hematological malignancies | 149 | 15.9 | 13.6-18.2 | ||
Timepoint of assessment (n = 937) | - New diagnosis | 572 | 61.0 | 57.9-64.2 | |
- Disease progression/relapse | 365 | 39.0 | 35.8-42.1 | ||
Carcinoma (n = 788) | - Stage | - I-III | 380 | 48.2 | 44.7-51.7 |
- IV | 408 | 51.8 | 48.2-55.3 | ||
Hematological malignancies (n = 149) | - Setting | - Curative | 48 | 32.2 | 24.7-39.7 |
- Palliative | 101 | 67.8 | 60.3-75.3 | ||
Comorbidities | CCI (0–37) (n = 937) | - No comorbidities: score 0 | 432 | 46.1 | 42.9-49.3 |
- Comorbidity score 1 | 232 | 24.8 | 22.0-27.5 | ||
- Comorbidity score ≥ 2 | 273 | 29.1 | 26.2-32.0 | ||
Pain | VAS (0–10) (n = 936) | - No pain: score 0 | 467 | 49.9 | 46.7-53.1 |
- Mild pain: score 1 – 3 | 144 | 15.4 | 13.1-17.7 | ||
- Pain to treat: score ≥ 4 | 325 | 34.7 | 31.7-37.8 | ||
Performance status | ECOG-PS (0–5) (n = 936) | - Score 0-1 | 677 | 72.3 | 69.5-75.2 |
- Score 2-4 | 259 | 27.7 | 27.3-33.1 | ||
Polypharmacy (n = 910) | - 0-4 different drugs | 427 | 46.9 | 43.7-50.2 | |
- ≥5 different drugs | 483 | 53.1 | 49.8-56.3 |
Screening
|
Cut-off
|
Score
|
n
|
%
|
95%CI
|
---|---|---|---|---|---|
fTRST (0–6) | ≥1 | - Absence of a geriatric risk profile : score 0 | 164 | 17.5 | 15.1-19.9 |
- Presence of a geriatric risk profile : ≤ 1 | 773 | 82.5 | 80.1-84.9 | ||
G8 (0–17) | ≤14 | - Absence of a geriatric risk profile : score > 14 | 240 | 25.6 | 22.8-28.4 |
- Presence of a geriatric risk profile : score ≤ 14 | 697 | 74.4 | 71.6-77.2 | ||
GA
|
Item/Instrument
|
Score
|
n
|
%
|
95%CI
|
Living situation (n = 937) | - Living alone | 283 | 30.2 | 27.3-33.1 | |
- Not living alone | 654 | 69.8 | 66.9-72.7 | ||
Functional status | ADL (6–24) (n = 937) | - Independent: score 6 | 455 | 48.6 | 45.4-51.8 |
- Dependent: score ≥ 7 | 482 | 51.4 | 48.2-54.6 | ||
IADL (0-5/8) (n = 937) | - Independent: score 8 (female) or 5 (male) | 399 | 42.6 | 39.4-45.7 | |
- Dependent: score < 8 (female) or 5 (male) | 538 | 57.4 | 54.2-60.6 | ||
Fall history in the past 12 months | Fallsb (n = 937) | - No falls | 642 | 68.5 | 65.5-71.5 |
- 1 fall without injury | 41 | 4.4 | 3.1-5.7 | ||
- 1 fall with injury | 114 | 12.2 | 10.1-14.3 | ||
- ≥2 falls without injury | 35 | 3.7 | 2.5-4.9 | ||
- ≥2 falls with injury | 105 | 11.2 | 9.2-13.2 | ||
Fatigue | MOB-T (0–6) (n = 937) | - No fatigue | 369 | 39.4 | 36.3-42.5 |
- Presence of fatigue | 568 | 60.6 | 57.5-63.7 | ||
Cognitionc
| MMSE (0–30) (n = 936) | - Normal cognition: score ≥ 24 | 837 | 89.4 | 87.5-91.4 |
- Mild cognitive decline: score 18–23 | 84 | 9.0 | 7.1-10.8 | ||
- Severe cognitive decline: score ≤ 17 | 15 | 1.6 | 0.8-2.4 | ||
Depression | GDS-15 (0–15) (n = 933) | - Not at risk for depression: score 0–4 | 741 | 79.4 | 76.8-82.0 |
- At risk for depression: score 5–15 | 192 | 20.6 | 18.0-23.2 | ||
Nutritiond
| MNA-SF (0–14) (n = 937) | - Normal nutritional status: score ≥ 12 | 340 | 36.3 | 33.2-39.4 |
- Risk of malnutrition: score 8–11 | 422 | 45.0 | 41.9-48.2 | ||
- Malnourished: score ≤ 7 | 175 | 18.7 | 16.2-21.2 |
Occurrence of falls and fall related injuries at baseline and at follow-up
Univariate predictors for falls (≥1 fall)
Variable | Total population (n = 809)* | Non-fallers (no falls) (n = 667)* | Fallers (≥1 fall) (n = 142)* | Single fallers (1 fall) (n = 69)* | Recurrent fallers (≥2 falls) (n = 73)* | P-value non-fallers vs fallers | P-value non-fallers vs single fallers | P-value non-fallers vs recurrent fallers | |
---|---|---|---|---|---|---|---|---|---|
Age | 70-74 | 322 (39.8%) | 278 (41.7%) | 44 (31.0%) | 23 (33.3%) | 21 (28.8%) | 0.0511 | 0.0955 | 0.1703 |
75-79 | 256 (31.6%) | 207 (31.0%) | 49 (34.5%) | 20 (29.0%) | 29 (39.7%) | ||||
≥80 | 231 (28.6%) | 182 (27.3%) | 49 (34.5%) | 26 (37.7%) | 23 (31.5%) | ||||
Gender | Female | 528 (65.3%) | 435 (65.2%) | 93 (65.5%) | 45 (65.2%) | 48 (65.8%) | 0.95 | 1.0 | 0.93 |
Male | 281 (34.7%) | 232 (34.8%) | 49 (34.5%) | 24 (34.8%) | 25 (34.3%) | ||||
G8 | No geriatric risk profile (>14) | 232 (28.7%) | 218 (32.7%) | 14 (9.9%) | 6 (8.7%) | 8 (11.0%) | <0.0001 | <0.0001 | 0.0001 |
Geriatric risk profile (≤14) | 577 (71.3%) | 449 (67.3%) | 128 (90.1%) | 63 (91.3%) | 65 (89.0%) | ||||
fTRST | No geriatric risk profile (0) | 153 (18.9%) | 147 (22.0%) | 6 (4.2%) | 2 (2.9%) | 4 (5.5%) | <0.0001 | 0.0002 | 0.0009 |
Geriatric risk profile (≥1) | 656 (81.1%) | 520 (78.0%) | 136 (95.8%) | 67 (97.1%) | 69 (94.5%) | ||||
ADL | Independent (6) | 413 (51.1%) | 375 (56.2%) | 38 (26.8%) | 16 (23.2%) | 22 (30.1%) | <0.0001 | <0.0001 | <0.0001 |
Dependent (≥7) | 396 (48.9%) | 292 (43.8%) | 104 (73.2%) | 53 (76.8%) | 51 (69.9%) | ||||
IADL | Independent (5(male)/8(female) | 367 (45.4%) | 325 (48.7%) | 42 (29.6%) | 18 (26.1%) | 24 (32.9%) | <0.0001 | 0.0003 | 0.01 |
Dependent (≤4(male)/≤7(female)) | 442 (54.6%) | 342 (51.3%) | 100 (70.4%) | 51 (73.9%) | 49 (67.1%) | ||||
Living situation | Not living alone | 571 (70.6%) | 486 (72.9%) | 85 (59.9%) | 42 (60.9%) | 43 (58.9%) | 0.002 | 0.0352 | 0.01 |
Living alone | 238 (29.4%) | 181 (27.1%) | 57 (40.1%) | 27 (39.1%) | 30 (41.1%) | ||||
Fall history in the past 12 months | No falls | 566 (70.0%) | 510 (76.5%) | 56 (39.4%) | 32 (46.4%) | 24 (32.9%) | <0.0001 | <0.0001 | <0.0001 |
Falls (≥1) | 243 (30.0%) | 157 (23.5%) | 86 (60.6%) | 37 (53.6%) | 49 (67.1%) | ||||
CCI | No comorbidities (0) | 388 (48.0%) | 326 (48.9%) | 62 (43.7%) | 27 (39.1%) | 35 (47.9%) | 0.26 | 0.1230 | 0.88 |
Comorbidities (≥1) | 421 (52.0%) | 341 (51.1%) | 80 (56.3%) | 42 (60.9%) | 38 (52.1%) | ||||
MOB-T for fatigue | No fatigue | 339 (41.9%) | 313 (46.9%) | 26 (18.3%) | 12 (17.4%) | 14 (19.2%) | <0.0001 | <0.0001 | <0.0001 |
Fatigue | 470 (58.1%) | 354 (53.1%) | 116 (81.7%) | 57 (82.6%) | 59 (80.8%) | ||||
Poly-pharmacy | Absence (0–4 drugs) | 386/785 (49.2%) | 338/649 (52.1%) | 48/136 (35.3%) | 22/66 (33.3%) | 26/70 (37.1%) | 0.0004 | 0.0037 | 0.02 |
Presence (≥5 drugs) | 399/785 (50.8%) | 311/649 (47.9%) | 88/136 (64.7%) | 44/66 (66.7%) | 44/70 (62.9%) | ||||
VAS for pain | No pain (0) | 408 (50.4%) | 359 (53.8%) | 49 (34.5%) | 23 (33.3%) | 26 (35.6%) | <0.0001 | 0.0012 | 0.003 |
Mild pain/pain to treat (1–10) | 401 (49.6%) | 308 (46.2%) | 93 (65.5%) | 46 (66.7%) | 47 (64.4%) | ||||
MMSE | Normal cognition (≥24) | 738 (91.2%) | 615 (92.2%) | 123 (86.6%) | 59 (85.5%) | 64 (87.7%) | 0.03 | 0.0566 | 0.18 |
Mild/severe cognitive decline (≤23) | 71 (8.8%) | 52 (7.8%) | 19 (13.4%) | 10 (14.5%) | 9 (12.3%) | ||||
GDS | Not at risk for depression (0–4) | 663/806 (82.3%) | 559/665 (84.1%) | 104/141 (73.8%) | 52/68 (76.5%) | 52 (71.2%) | 0.004 | 0.1095 | 0.006 |
At risk for depression (≥5) | 143/806 (17.7%) | 106/665 (15.9%) | 37/141 (26.2%) | 16/68 (23.5%) | 21 (28.8%) | ||||
MNA-SF | Normal nutritional status (≥12) | 412 (50.9%) | 367 (55.0%) | 45 (31.7%) | 21 (30.4%) | 24 (32.9%) | <0.0001 | <0.0001 | 0.0003 |
Risk of malnutrition/malnourished (≤11) | 397 (49.1%) | 300 (45.0%) | 97 (68.3%) | 48 (69.6%) | 49 (67.1%) | ||||
ECOG PS | Score 0-1 | 619/808 (76.6%) | 529/666 (79.4%) | 90 (63.4%) | 42 (60.9%) | 48 (65.8%) | <0.0001 | 0.0004 | 0.0073 |
Score 2-4 | 189/808 (23.4%) | 137/666 (20.6%) | 52 (36.6%) | 27 (39.1%) | 25 (34.3%) |
Multivariate predictors for falls (≥1 fall) during follow-up
Coefficients | Wald Chi Square | p-value | |||
---|---|---|---|---|---|
-1.846 | 130.4 | <0.0001 | |||
Selected baseline variables | Coefficients | Wald Chi-Square | p | Odds ratio’s | 95% CI |
Fall history in the past 12 months (fall history vs no fall history in the past 12 months) | 0.684 | 43.3 | <0.0001 | 3.926 | 2.612-5.901 |
ADL (ADL independent vs ADL dependent) | -0.354 | 9.5 | 0.002 | 0.492 | 0.314-0.772 |
MOB-T for fatigue (no fatigue vs fatigue) | -0.484 | 13.7 | 0.0002 | 0.380 | 0.228-0.634 |
Geriatric risk profile by G8 (no geriatric risk profile vs geriatric risk profile) | -0.377 | 5.5 | 0.019 | 0.471 | 0.251-0.883 |
Living situation (living alone vs not living alone) | 0.245 | 5.2 | 0.023 | 1.631 | 1.071-2.482 |